Health Sector Reform Programme of Trinidad

	Ministry of Health
	Health Sector Reform Programme of Trinidad & Tobago Bringing Healthcare closer to you !

Address of the Honourable Colm Imbert Minister of Health, Republic of Trinidad and Tobago

Chairman, Honourable Patrick Manning, Prime Minister of Trinidad and Tobago, my Cabinet colleagues, Secretary for Health and Social Services, Tobago House of Assembly, Ms Cynthia Alfred; Country Representative of the Pan American Health Organisation, Dr. Lilian Reneau-Vernon; Representative of the Inter American Development Bank, Mr. John Yates; Chairman of the Regional Health Authorities, Senior officers of the Ministries of Health, Planning, Finance, Representative of the professional organisation, Religious organisation, Trade Unions, Non-Governmental organisation, community-based organisation, distinguished guests, Ladies and Gentlemen:

It is a pleasure for me to welcome you and thank you for responding to my invitation to this signal event in our quest for improving the Health Services in Trinidad and Tobago.

Your response has confirmed that you understand the importance of maintaining dialogue on an issue that is critical to our survival. It also endorses what the largest public opinion survey in the world undertaken by Gallup International for the Millennium Report of the Secretary General of the United Nations shows that good health and family life ranked first among things people valued – far out ranking material possessions.

Ladies and Gentlemen, you will recall that our previous People’s National Movement (PNM) Government had convened a series of consultations to inform the development of the Health Sector Reform Program. Those consultations were comprehensive and inclusive involving stakeholders at the highest governance levels. Indeed, it is the view of many experts in the field that this emphasis on participation and consultation contributed to the fact that very few changes were made in the design of the reform program when the Government changed in 1995.

Six years have gone by since the launching of the reform program and therefore it is logical and good management that I should want an in depth view of what has transpired. It has also been important to review the changes in the pattern of diseases and health problems, the trends in the population distribution and the new technologies that might require modification to reform the program. From the beginning I have focused on talking and consulting with you. Over the past few months I have visited numerous health facilities and seen first hand the dedication of the health staff and learned of the challenges faced in the delivery of health care on a daily basis. I/we need to know what has worked what has not worked, and why – from the perspective of the clients as well as from the providers.

Let me remind you of the objective of the Health Sector Reform Program (HSRP). It is to enable the Government of the Republic of Trinidad and Tobago (GORTT) to improve the health status of the population by promoting wellness and providing affordable quality health care in an efficient and equitable manner. I do not intend to give a status report on the reform, which will be done by Mrs. Valerie Alleyne-Rawlins. However, I would like to briefly highlight the major activities that have taken place. The major ones have revolved around the changing role of the Ministry of Health (MOH) and the decentralization of service delivery to the Regional Health Authorities (RHAs).

Let me briefly review some of our major reform activities beginning with a change in role of the Ministry of Health and the decentralisation of service delivery to Regional Health Authorities. This is perhaps the philosophic underpinning of the entire reform process. On the one hand, the Ministry had to be reorganized to carry out its functions of policy formulation, planning, monitoring, evaluation and regulation; while Regional Health Authorities face the challenge of introducing completely new management structure and systems to operate the health care service in each region. In short, modern organisational and management systems needed to be introduced if we were to provide the quality of service the public has come to expect.

You will recall at the time health systems globally were searching for new ways, new models for delivering health services, since existing methodologies were no longer adding value or effective. Trinidad and Tobago was no exception.

We have made some progress in helping smooth this transition. For example, we are developing model RHA human resource and finance and accounting systems using the North West Regional Health Authority as a field laboratory. Approved model systems will then be “rolled out”, to the remaining RHAs. It is intended that the model systems will integrate programme and administrative systems, introduce service monitoring mechanisms and effect training programmes to develop administrative and support skills.

We have undertaken other initiatives to further support the new roles of the Ministry and the RHAs to achieve a shift in resources from secondary and tertiary care to primary health care development, disease prevention, health promotion and basic curative health services as close to the community as possible.

These include:

® The funding of several pilot projects in primary health care around the country. These projects look at innovative new ways in bringing appropriate care to people – from the way diabetes clinics are conducted at the ERHA to the ways drugs are dispensed in the NWRHA

® The development of a comprehensive action plan to protect our population from infectious diseases including dengue fever

® The development of mental health plans for each of our regions

® The development of an action plan to provide free prescription drugs and over-the-counter non-prescription drugs at point of delivery for pensioners and for persons over the age of 65

® The creation of a National Strategy to deal with HIV/AIDS

® Implementation of a number of initiatives related t our national programmes including the National Blood Transfusion Service, national surveillance unit, public and hospital laboratories and tuberculosis, including the introduction of the international DOTS standard to treat TB.

In addition, Trinidad and Tobago actively participated in the recent process in Geneva, Switzerland, which culminated in the signing of an international public health treaty called the Framework Convention for Tobacco Control. The purpose of the treaty is to help prevent initiation to smoking among youth.

We have also made major improvements in the delivery of ambulance services in Trinidad and Tobago. The pilot project has been completed and the findings are presently informing the implementation of a comprehensive national ambulance service. The national ambulance service will include a fleet of properly equipped ambulances, a state of the art radio communication network and a cadre of trained emergency medical technicians. Successful implementation of a national ambulance service is a major step in the planning and development of a comprehensive and integrated Emergency Health System for Trinidad and Tobago.

Cognisant of the need for quality, my Ministry collaborated with National Training Agency to ensure that training programmes were accredited and EMT standard were developed for Trinidad and Tobago.

We have not neglected our secondary and tertiary sector. After all, services must be provided since in spite of all out efforts people will fall ill.

Key initiatives include

- National Oncology (Cancer Care) Programme

- Upgrading of surgical suites and systems to clear up the long times for surgery

- Expanding cardiology services

- Introduction of new systems to improve access and response time

While progress has been made, much more remains to be done. For example, human resource management continues to be one of the most challenging areas in our reform programme. Out strategy calls for the development of incentives to increase productivity and efficiency and the complete transition from employment in the public service to Regional Health Authority employment.

But no matter how well trained and skilled the health care professional may be, they cannot deliver high quality care without the necessary infrastructure in terms of the buildings, equipment, drugs, supplies and efficient support system.

For this reason, we have embarked upon a substantial investment programme in the development of the physical infrastructure of health facilities at the primary level. For example we have made significant progress in the rebuilding, refurbishing, adapting in some ninety plus (90+) health and outreach centres across the Country as part of this primary health care thrust. The investment programme has been supported and will continue to be the focus of a great deal of technical assistance in the areas of health promotion, primary health care development, recruitment, training and re-training of staff, establishment of private/public sector partnerships etc. In addition, we are implementing a maintenance and engineering service for our hospitals and primary care facilities so that both the facilities and their equipment are properly maintained to ensure patient safety.

Ultimately however, a health reform programme is of little use unless it results in enhanced quality of care for the clients. In this regard, we have taken steps to introducing a system of continuous quality improvement that is customer focused and outcome oriented. We have made significant progress here and are particularly proud of our achievements in this area. The details of which will be discussed in other presentations. Following on the establishment of the Health Sector Quality Council we are currently involved in the implementation of risk management and other monitoring systems.

It is also important that I touch on health financing, an area in which I believe we must take firm and decisive action.

The current system of financing the entire system from general taxation is neither sustainable nor equitable. The citizens of this country must pay doubly for their health care – since they first pay a contribution through general taxes and then when public services don’t meet their expectations, they seek care in the private sector, usually from out-of-pocket expenses. Arriving at an appropriate mix of public and private financing is crucial; for the long-term sustainability of the system and the number of options. Nevertheless, it is now time to examine the question of health financing in all its dimensions. My Government is committed to do this.

Ladies and Gentlemen, I have chosen this brief review of our major health sector reform implementation activities to draw attention to the challenges we face in Trinidad and Tobago.

In this regard, Trinidad and Tobago is not unique. Similar issues are currently being addressed in both developed and developing countries around the world. The reason is that a health system is not a static, unchanging or monolithic entity. It is an evolving, ever changing enterprise usually built on a set of complex financing and organizational partnerships among a variety of groups including payers, providers, consumers of services and other stakeholders within the system. No matter how much progress has been made with respect to any or all of these arrangements or partnerships or how many specific reform initiatives have been introduced, challenges will remain and emerge as the system evolves.

As I indicated at the outset, we recognise the need for partnership if health sector reform has any chance of succeeding. We need a constructive and positive relationship with all our partners. It is the reason we are here today. There will be ample opportunity for questions, discussion and interaction. I believe that this is not only sound business practice but also good human relations.

We are committed to this process and to the idea of fundamentally reforming the way we conduct the business of the Sector. This is a challenge we must meet head on. We need to be innovative and work towards re-engineering bureaucratic processes to find ways of solving problems. Out government will not be complacent. We will be vigilant in driving, monitoring and supporting the way forward. In essence this can only be achieved through effective partnership; for health, economic growth, the environment, and a whole range of personal freedoms are inextricably linked in their contribution to human development. Alleviation of suffering and improvement of the quality of life of the citizens of Trinidad and Tobago are among our primary objectives.

Today, I ask you to join me in transforming our vision into a reality, ensuring that we successfully build a sustainable quality health system to serve Trinidad and Tobago’s generations of the twenty-first century.

Thank you. I look forward to meaningful deliberations as we chart the course forward.

May God bless us all.

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